Mental Health for Autistic Adults: Finding the Best Provider

By Eric Levine, Ed.D with Becky Shipkosky

Autism spectrum disorder, or ASD, refers to a neurodevelopmental difference with which about 1% of the world’s population (World Health Organization, 2023) and 2.2% of US adults are diagnosed (Centers for Disease Control, 2023). ASD is accompanied by comorbidities in 50 to 70% of autistic people (Hours et al., 2022), many of which are mental health and behavioral disorders, including:

• Anxiety disorders, including generalized anxiety (GAD), social anxiety, and obsessive-compulsive (OCD).
• Bipolar disorder (BD).
• Disruptive mood dysregulation disorder (DMDD).
• Oppositional defiant disorder (ODD).
• Depression.
• Eating disorders.
• Suicidality.

In and of itself, autism is not a condition to be cured or recovered from, but certain aspects of life, including mental health, can be made easier and more manageable with proper support. Recent research indicates that mental health services are a tremendous piece of the support puzzle for autistic adults (Chan, Doran, 2023), and access to such services is woefully limited but growing (Maddox, Gaus, 2019).

Why Is Autism Accommodation in Mental Health Important?

At the most basic level, as Maddox and Gaus (2019) articulate, “Untreated psychiatric conditions in autistic adults are associated with a host of negative outcomes, including adaptive functioning impairments, difficulties with employment and independent living, and poor quality of life.” This unequivocally makes the case for helping autistic adults address mental health concerns, but it doesn’t get to the heart of why it’s so important to provide integrated and individualized care.

Carol Maher, Cooperriis’ neurodiversity coordinator, explains that an integrated approach provides opportunities for program participants to embrace their strengths and adapt. The key to this approach lies in the understanding that autism is an integral part of who a person is, and without space to express their full being, including autism, mental health recovery is not possible. No aspect of an individual’s self can be set aside in the recovery journey.

What Does It Look Like to Accommodate Autism in Mental Health Recovery?

While sensory toys, noise-canceling headphones, and quiet rooms are excellent steps in the direction of accommodating autism in a recovery program setting, Maher lays out some tangible communication and support tools for deeper, autism-informed accommodations (Maher 2023):

• Affirmations help reinforce strengths, successes, and efforts to change.
• Advice or feedback when appropriate, and after asking and receiving consent, can contribute to new self-awareness.
• Open-ended questions encourage participants to share their experiences and thoughts and better understand their preferences and limits. (“What was that like for you?”)
• Reflective listening, or paraphrasing a person’s feelings or words back to them, helps in building empathy and self-awareness.
• Simple encouragements, such as "You can do it" or “You’re awesome,” can have a positive impact.
• Direct, immediate commands or statements may sound rude to neurotypical people but can match an autistic person’s communication style well.
• Restricting choices to two options can prevent overwhelm.
• Encouraging individuals to consider their personal needs and the effects of their actions can provide perspective.
• Establishing a sleep and rest routine promotes recovery and better internal resources.
• A solution ladder is a helpful visual guide, detailing the first, next, and last steps to solving any problem.
• Knowing one’s own triggers and building a toolkit for coping can help any neurodivergent person thrive.

Choosing a Program With the Right Accommodations

Given the limited mental health services available to autistic adults, how can you find programs and choose the best fit for you or your loved one? Psychology Today has robust directories for both therapists and treatment centers. Upon visiting either of these pages, select your location and then select autism under the Issues tab.

Next, how do you know if something is the right fit for you or your loved one? Start with a list of therapists or residential programs who list autism among their areas of experience, and then sort for location and any insurance needs. From there, begin to call to find out if the provider is accepting new clients. At this stage, you can finally begin to screen for fit. Here are some points to consider in your search (Hansen, 2024) (Maher, 2024).

Choosing General Mental Health Services

When you’re seeking a therapist or other non-residential mental health service, consider the following:

• Autism-informed providers: Anyone who works with autistic individuals in a mental health setting should also have a comprehensive understanding of neurodiversity to provide knowledgeable and empathetic support.
• Personalized care: Support should be flexible enough to be tailored to individual needs.
• Strengths-based empowerment: Look for providers who help clients identify and leverage their unique abilities and contributions rather than concentrating on correcting perceived deficits.
• Clear and nonjudgmental communication: Look for providers who know how to engage in open, straightforward verbal communication that is free of judgment and unnecessary nuance.
• On the spectrum: While not a requirement, therapists who are themselves autistic come with a built-in understanding of what it means to be neurodivergent in a neurotypical world (Hemachandra, 2024).

Autism Essential Reads

Reducing Meltdowns in Children With Autism Spectrum

5 Reasons Why Girls' Autism Symptoms Are Often Missed

Choosing a Residential Treatment Program

If you’re looking for an autism-friendly residential mental health program to help yourself or a loved one, the following qualities may also be important:

• Sensory considerations: A facility should have sensory-friendly spaces, such as areas to be alone and dining accommodations away from the noisy kitchen.
• Dietary flexibility: Whether or not you or your loved one need(s) it, a program catering to specific diets or sensitivities is a promising indicator of their commitment to comprehensive accommodation.
• Family resources: Specialized resources for families often include education and support for the all-important transition of leaving the program.
• Inclusive living model: If it’s appropriate, such as for high-functioning autistic residents, a residential program that provides a fully inclusive model can dramatically improve clients’ real-world outcomes.

While the intersection of autism and mental health is lacking, as are so many such intersections, there is hope for ongoing improvement. Advocates are working to raise awareness at the government and community levels, and autistic adults and their families can help in big and small ways by educating their community, contacting legislators and governing bodies, sitting on advisory boards, or even simply signing petitions. The Autism Self Advocacy Network is a helpful entry point for anyone looking to get involved (Hemachandra, 2024).